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There's more than one way to reform health care system

A national writer has shown us what works, and he came to Maine to help honor local initiatives.

Global health care's most celebrated sore shoulder was in town last week. The shoulder is attached to T.R. Reid, longtime Washington Post and NPR correspondent.

Three years ago Reid, who had been the Post's bureau chief in both London and Tokyo, had the idea that he would write a book about the differences in health care systems around the world.

The test he would use to discover how different countries' systems work would be his chronically sore shoulder, the result of an accident when he served in the Navy shortly after graduating from college.

The result of a year of travels in search of a solution to his shoulder problems was a brilliant work, "The Healing of America" – the subject of this column in November 2009.

Reid's timing was perfect. His book came out just as the debate on health care reform was in full swing.

Moreover, the book is engaging, readable, fact-based and devastating to the U.S. approach to health care.

Reid's thesis is simple: All other developed countries in the world provide health care to all their citizens at roughly half the cost of our system, usually with better results. The United States could adopt any one of several approaches and get better results.

If President Obama read Reid's book, it was not apparent from the health care legislation passed last year. However, the debate over the impact of the complex law has made Reid a major draw.

Here in Portland, the World Affairs Council and the Daniel Hanley Center for Health Leadership sponsored Reid's visit. He was the keynote speaker at the awards dinner and participated in a panel in the afternoon.

The afternoon panels showcased the work Maine is doing as part of an innovative grant program called "Aligning Forces for Quality" sponsored by the Robert Wood Johnson Foundation.

Surprisingly, Maine is at the forefront of states developing ways to improve the quality and delivery of health care. All of the practitioners who spoke about the work they are doing were engaging and passionate about improving patient outcomes and experiences. Check out www.getbetterme.org .

The site is still in development but should be one of the first in the country to show comparative measures of health care provider performance.

Maine is developing a set of young, able leaders in health care quality. I was impressed with Elizabeth Mitchell (the daughter of the Libby Mitchell who ran for governor), CEO of the Maine Health Management Coalition, Dr. Lisa Letourneau, executive director of the Maine Quality Initiative, and Dr. Eric Steele, chief medical officer of Eastern Maine Health Care Systems, all of whom had prominent roles in this conference.

The hardest slog of the afternoon was the 45 minutes Dr. Robert Berenson, national health care policy expert from the Urban Institute, was given to explain the most important features of the Affordable Healthcare Act, the proper name for ObamaCare.

Dr. Berenson had a presentation of 38 slides, each crammed with information. Fortunately for us lay people, Berenson knows his stuff, blazing through many of the slides with a knack for summary.

I took two things out of the presentation. First, there is lots of money in the law for innovation – a good thing. Second, in spite of the law's attempts to encourage paying for healthy outcomes, the current, much-abused fee-for-service approach is likely to be around for a long time. So, we need to make it work better.

Here Reid, a member of the second afternoon panel, was encouraging in noting that most of the other developed countries had, in fact, figured out how to make fee-for-service systems work.

Reid elaborated on this point in his keynote address in the evening session. But lest I forget, a memorable and heartening aspect of the dinner session was the recognition awards given to nine Maine organizations for the extraordinary work they are doing to improve health care in the developing world. These organizations may be found at www.hanleytrust.org.

Let me end by saying Reid is not enthusiastic about our recent health care legislation. He suggests it does do a few good things, mainly in extending care to more Americans and in removing some of the onerous practices of our insurance companies.

Nonetheless, the new law does not adequately address the unsustainable cost growth of our current approach, and it in fact expands an already overly complex model for delivering health care.

Reid delivers this sobering message with surprising equanimity. I hope this is because he knows so much more than we do that he understands how the U.S. system will be saved in spite of itself. Or maybe he just enjoys after-dinner speaking.